Provider Demographics
NPI:1750738506
Name:FOUNTAIN COMMUNITY HEALTHCARE SERVICES
Entity type:Organization
Organization Name:FOUNTAIN COMMUNITY HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:KOFI
Authorized Official - Last Name:KPONYOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MBA
Authorized Official - Phone:502-542-0964
Mailing Address - Street 1:111 FAWN RUN DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8402
Mailing Address - Country:US
Mailing Address - Phone:502-542-0964
Mailing Address - Fax:502-868-9152
Practice Address - Street 1:1232 PARIS PIKE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9701
Practice Address - Country:US
Practice Address - Phone:502-542-0964
Practice Address - Fax:502-868-9152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care